<?php /* Smarty version 2.6.18, created on 2010-03-15 20:02:57
         compiled from paymentpopup.tpl */ ?>

<form name="paymentForms" id="paymentForms">
<input type="hidden" name="organism_id" value="<?php echo $this->_tpl_vars['organism_id']; ?>
">
<input type="hidden" name="key" value="<?php echo $this->_tpl_vars['key']; ?>
">
<input type="hidden" name="gender" value="<?php echo $this->_tpl_vars['gender']; ?>
">
<input type="hidden" name="size" value="<?php echo $this->_tpl_vars['size']; ?>
">
<table class="popup" border="0" cellspacing=0 cellpadding=0>
	<tr><td><div class="pop"><div class="top_pop"><img src="/app/default/www/images/top_left_pop.jpg" /></div> 
		<div id="drag_bar"><h2 class="pop_h2">&nbsp;Payment</h2></div>
		<div class="content">
			<div id="paymentPanel">
				<div style="border: 1px #8B8378 solid; padding:5px 5px 5px 5px;background:#FDFCDC;">
					<?php echo $this->_tpl_vars['supplierpaymentinfo']['notice']; ?>

				</div>
				<div style="margin-top: 10px;">
					<table border="0">
						<tr>
							<td>Invoice/Reference Number :</td>
							<td align="left"><input type="text" name="user[reference_no]" value="<?php echo $this->_tpl_vars['supplierpaymentinfo']['reference_no']; ?>
" READONLY style="width:110px"></td>
						</tr>
						<tr>
							<td>Date paid : </td>
							<td align="left"><input type="text" name="user[date_paid]" value="mm/dd/yyyy" style="width:110px" onclick="javascript:this.value='';"></td>
						</tr>	
						<tr>
							<td>Amount : </td>
							<td align="left"><input type="text" name="user[amount]" style="width:110px"></td>
						</tr>	
						<tr>
							<td>Wire Fees : </td>
							<td align="left"><input type="text" name="user[wire_fees]" style="width:200px"></td>
						</tr>	
						<tr>
							<td>Telegraphic Transfer Confirmation Number : </td>
							<td align="left"><input type="text" name="user[tt_no]" style="width:200px"></td>
						</tr>	
						<tr>
							<td style="vertical-align:top;">Comments : </td>
							<td align="left"><textarea name="user[comments]" style="width:250px"></textarea><td>
						</tr>	
						<tr><td height="10"></td></tr>
						<tr>
							<td colspan="3" align="center">
								<input id="btnBack" name="btnBack" type="button" value="&lt;&lt;Back" onclick="popup('payment');">&nbsp;
								<input id="btnSave" name="btnSave" type="button" value="Save" onclick="doajaxAction('/account/savepopupPayment/id/1',1,'test',document.getElementById('paymentForms'),false)">
							</td>
						</tr>																																																																																		
					</table>												
				</div>
			</div>
		</div>	
	<div class="btm_pop"><img src="/app/default/www/images/btm_left_pop.jpg"  alt="" />
	</td></tr>
</table>
</form>
<div id="test">

</div>

